2024 Lost Canyon Wk 4

WHERE: Lost Canyon Camp in Williams, AZ

WHEN: June 24-28, 2024

How do we get there? On a bus!

Departure: 1 Day before camp, SUNDAY 06/23, Location & Time TBA

Return: 06/28 Late evening, exact time TBA

COST: $ 500, a deposit of $ 40 is required to hold your spot.

Payment Plans are available, and fundraising options.

Money is nonrefundable after April 30th.

After completing this form, a confirmation will be sent with the information entered below. You will then receive an access code and registrant ID # (screenshot this or write it down); you will need this for your camp health forms.

Questions?

Contact Marissa Ramirez-Mussotto at:

209-489-8557 (call/text)

[email protected]

Guest Type

Are you bringing a child?

Registration Options

Registration Option #1 ($500.00)
Please select this option to make a deposit or full payment below with a card. Your card will not be immediately charged, and monthly payments will be available.
Registration Option #2 ($500.00)
This option is for complete fundraising or cash-only payment plans.

Participant Name

Date of Birth

Phone

Phone Type

Participant Address

Gender

Male
Female

Ethnicity

Other Languages Spoken

T-shirt Size

High School Graduation Year

Parent / Guardian Information

This is for campers under 18 years of age. We will need your Parent or guardian's consent and information. All forms will be emailed to parent's email if under 18.

Parent/Guardian Name

Parent/Guardian Phone

Yes, it's okay to send me text messages including confirmations, changes, and updates. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

Phone Type

Parent/Guardian Email

Address is same as participant

Parent/Guardian Address

Parent / Guardian Information

Billing Information